Gov. Rick Scott's budget delves into Obamacare

Published On: Feb 01 2013 04:47:24 PM EST

TALLAHASSEE, Fla. -

Gov. Rick Scott proposed a health-care budget Thursday that would trim payments to hospitals and carry out some parts of the federal Affordable Care Act --- but he did not take a position on whether the state should go along with a major expansion of the Medicaid program.

Scott said he needs to better understand how the Medicaid expansion would affect health-care quality, access and costs. The Affordable Care Act, better known as Obamacare, calls for such an expansion, but each state has final say.

"Today is not the day for that decision,'' Scott said during a news conference to announce an overall $74.2 billion budget proposal that now goes to the Legislature.

"There is still no money in his budget for expanding Medicaid, ignoring the overwhelming support by a majority of Floridians to broaden the program, and assuring Florida’s role as a national leader in the number of uninsured citizens,'' Smith said.

Scott's budget calls for spending about $30.9 billion on health- and human-services programs next year. It includes money for such things as providing more residency slots for medical students and offering services to about 750 developmentally disabled people who are on a waiting list.

The Florida Medical Association praised Scott's move to add about 700 residency positions, which the governor's office says will ultimately increase the likelihood that new doctors will stay in the state.

"The governor clearly understands the importance of having a substantial supply of physicians to meet the increasing health-care needs of Florida's families,'' FMA Executive Vice President Timothy Stapleton said. "His commitment to GME (graduate medical education) funding will pay dividends to the state of Florida for years to come."

Some other parts of the health-care budget, however, would face cuts. For example, most hospitals would see a 2 percent cut in Medicaid rates for inpatient care, county health departments would see their reimbursed rates reduced and funding for chiropractic and podiatric services would be eliminated, according to the governor's office.

Health and human services providers have repeatedly tried to fend off funding cuts in recent years as the state has grappled with budget shortfalls and growing Medicaid costs. But Scott's budget proposal does not appear to include the broad range of potential cuts that have worried providers in the past.

One of the most closely watched issues during the upcoming session, however, will be how Scott and the Republican-controlled Legislature deal with the Affordable Care Act, which President Obama and congressional Democrats approved in 2010.

The state is required to comply with certain parts of the law, but others are optional. Also, some parts of the law carry budget consequences, while others don't.

Scott's proposed budget would carry out parts of the law that are mandatory or, in effect, leave little choice for the state.

For example, the proposal includes $703.5 million for a mandatory increase in Medicaid payment rates for primary-care physicians. The increase, which brings Medicaid rates to higher Medicare levels, is totally funded by the federal government, though it shows up in the state budget.

The budget also includes $116.3 million in state and federal money to cover an expected influx into Medicaid of people who are currently eligible for the program but have not enrolled. With the Affordable Care Act fully taking effect in 2014, it is widely expected that some already-eligible people will start moving into the Medicaid system --- an issue that is separate from the Medicaid eligibility expansion in the federal law.

As another example, the budget calls for opening up eligibility in the state-employee health insurance program to what are known as "other personnel services," or OPS, workers. Those people are considered temporary employees and are not currently eligible for enrollment in the state health-insurance program.

But the Affordable Care Act requires employers such as the state to provide coverage to all employees who work more than 30 hours a week. As a result, the state has to offer coverage to such OPS employees or face paying hefty penalties.

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